The relationship between changes in blood acid-base balance and electrolytes and ASA grading during liver transplantation / 解放军医学杂志

ABSTRACT

Objective To observe the changes in acid-base balance and the contents of electrolytes in patients during liver transplantation to explore the relationship between such changes and ASA grading, and to look for an optimal anesthetic intervention. Methods Arterial pH, PaO_2, PaCO_2, HCO~-_3, BE, K~+, Ca~ 2+ , Na~+, and glucose were monitored in 89 patients undergoing liver transplantation at four specific periods before anesthesia (T_0), after skin incision (T1), 10 minutes before reperfusion (T_2), and 10 minutes after reperfusion (T_3). Changes in blood acid-base and electrolyte parameters of the patients with different ASA status were compared. Result The pH and BE in ASA V patients was significantly lower at T_0, T_1, T_2 and T_3, and HCO~-_3 was lower in ASA V at T_3. The PaCO_2 in ASA V patients was significantly higher at T_0, T_1 and T_2. The Na~+ content in ASA V patients was significant higher at T_2 and T_3. At T_0 and T_1, the glucose level in ASA Ⅳ and Ⅴ were significant higher than in ASAⅢ. Significant differences in pH, PaCO_2, HCO~-_3, BE and glucose level were observed at different stages of the surgical procedure. The pH, BE and HCO~-_3 were significantly lowered at T_2 and T_3. Mean glucose and HR levels were gradually increased from T_1 to T_3. Conclusion Patients with advanced ASA grades are more prone to acid-base and electrolyte disturbances during reperfusion of the liver transplant. High ASA grades contitute an increased risk for cardiovascular collapse after reperfusion, calling for proper treatment.